China today is experiencing a rural health crisis, one that has uncomfortable echoes of the past. Within China's 'second society' of the peasantry, a resurgence of historical health problems (including vulnerability of the rural poor to epidemics such as schistosomiasis and tuberculosis and high rates of infant and maternal mortality) merge with contemporary concerns over HIV/AIDS, respiratory problems and the threat of Avian Flu to seriously threaten the health and welfare of people in rural areas. This review illustrates and explores the roots of this crisis in terms of key processes of social and environmental change and state health care policy. We argue that this crisis can only be resolved via a fundamental rethink of health provision across China, one that focuses especially on the poorest, most remote parts of the nation (both spatially and socially), and in which the privatisation of health care is more evenly balanced by increased state investment in basic health provision.